Pathology/Lab Coding Alert

Although they-re not eligible for reporting and garnering Physician Quality Reporting Initiative (PQRI) bonus pay, many of the current performance measures require physicians to order specific lab tests -- and that could affect your lab's bottom line.

Read on to learn some of the tests that are part of the performance measures and determine how it might impact your lab.

Only physicians and statutorily specified non-physician providers can participate in PQRI -- and that doesn't include PhD clinical scientists, laboratory technologists, pathology assistants or other non-physicians commonly associated with a laboratory, according to Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., in Simpsonville, Ky., and publisher of Pathology Service Coding Handbook.

But that doesn't mean labs should ignore the growing PQRI program. Some experts think that the lab-test- related quality measures may promote the use of certain tests among physicians who were not previously ordering those services.

For instance: The following performance measures demonstrate just some of the tests that your lab might see

more of when physicians align their ordering patterns with these patient quality-of-care standards. Choose the appropriate code based on the test your lab performs:

*Quality measures for diabetes patients, including

Measure 1. Hemoglobin A1c testing

- 83036 -- Hemoglobin; glycosylated (A1c)

Measure 2. LDL control

- 80061 -- Lipid panel
- 82465 -- Cholesterol, serum or whole blood, total
- 83700-83704 -- Lipoprotein, blood -
- 83721 -- Lipoprotein, direct measurement; LDL cholesterol

Measure 119. Urine protein screening for neuropathy

- 81050 -- Volume measurement for timed collection, each
- 82042-82044 -- Albumin; urine -
- 84156-84160 -- Protein, total ...

- 84165-84166 -- Protein -

Quality measure for children with pharyngitis

Measure 66. Group A streptococcus testing for children who received an antibiotic prescription for pharyngitis

- 87070-87071 -- Culture, bacterial -
- 87081 -- Culture, presumptive, pathogenic organisms, screening only
- 87430, 87650-87652 -- Infectious agent antigen detection - Streptococcus, group A -

You can learn more in Appendix H of your CPT 2008 manual or on the Internet at http://www.ama-assn.org/go/cpt.